THE MEDICAL COUNCIL OF HONG KONG

Application for Limited Registration

under section 14A of Medical Registration Ordinance

(Promulgation No. 4)

I apply for registration as a medical practitioner with limited registration in accordance with section
14A of the Medical Registration Ordinance pursuant to Promulgation No. 4 of the Medical Council on
Limited Registration. My personal particulars are as follows –

(a) Surname (English) : _________________________(Chinese) : _________________________

Given name (English) : ________________________(Chinese) : _______________________
(b) Date of birth : _________________________
(c) Gender : *Male/Female
(d) *Hong Kong Identity Card No. _________________________ and/or
*Passport No. ______________issued by______________ (country) in _____________ (place)
(e) Address : ____________________________________________________________________
____________________________________________________________________________
(f) Telephone number : __________________________________________
(g) Fax number : _______________________________________________
(h) E-mail address : _____________________________________________

2. I have been selected for employment in Hong Kong as a medical practitioner in the following
institution for medical duties specified in the Promulgation No. 4 of the Medical Council on Limited
Registration gazetted on 9 November 2001 –

Name and Address of Name and Address of Nature of duties to be Period of

Institution(s) with which the the Clinic(s) performed employment
clinic(s) is registered (診療所名稱及地址)
(就診療所註冊的社團
的名稱及地址)
(English) (English)

(Chinese) (Chinese)

3. I hold the following qualifications −

______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

1
(Rev. Apr 2018)
4. I have had the following post-qualification clinical experience −
______________________________________________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

5. I *am at present / have previously been registered with limited registration under Promulgation
No. 3. My registration number under Promulgation No. 3 *is / was _____________________.

6. I confirm that <See Note > −

(a) I *have/have never been convicted of a criminal offence punishable with imprisonment
(irrespective of whether actually sentenced to imprisonment) in Hong Kong or elsewhere.
(b) I *am/am not currently the subject of any on-going criminal proceeding(s) in Hong Kong or
elsewhere.
(c) I *have/have never been found guilty of professional misconduct by any professional body in
Hong Kong or elsewhere.
(d) I *am/am not currently the subject of any on-going disciplinary proceeding(s) by any
professional body in Hong Kong or elsewhere.

(* delete as appropriate)

<Note> : If there is any such conviction, finding of professional misconduct, or criminal or disciplinary
proceedings, full details must be provided.

2
(Rev. Apr 2018)
Statutory Declaration

WARNING
Applicant must ensure the truth and accuracy of all information provided. Making a
false declaration (including failure to disclose relevant information) is an offence
punishable with imprisonment under the Crimes Ordinance. Cases of false declaration
will be reported to the relevant authorities for investigation and prosecution.

I __________________________________________ (Applicant’s name) of _______________________

_____________________________________________________________________________ (address)

solemnly and sincerely declare that all information and documents

provided for this application are true and accurate.
Applicant’s
recent photograph

(administrator of
oath to sign
across the affixed
photograph of the
applicant)

(size: 40 x 60mm
to 50 x 70mm)

I make this solemn declaration conscientiously believing the same

to be true, and by virtue of the Oaths and Declarations Ordinance.

Applicant’s Signature :

*************************************************************

The above declaration was made on ________________ (date) at_______________ (place)

Before me (administrator of oath),

Signature: ____________________________________

Name: ___________________________(BLOCK letters)

*Status: □ Commissioner for Oaths □ Solicitor

□ Barrister □ Notary Public Official Stamp

Address: ______________________________________________________________

Tel. No.: _______________________ Email: ___________________________

*A declaration made outside Hong Kong must be made before a Notary Public.

(Rev. Apr 2018) 3

 THE MEDICAL COUNCIL OF HONG KONG

Application for Limited Registration under Promulgation No. 4

Character Reference (1)
I recommend ________________________________(Applicant’s name) for limited registration as
a medical practitioner under section 14A of the Medical Registration Ordinance.

I am not a relative of the Applicant. I have known the Applicant for at least 12 months. I have
sufficient opportunity of judging the Applicant’s character, in the following capacities:-

In my judgment, the Applicant is a person of good character and is fit and proper to be registered as
a medical practitioner with limited registration.

I have the following additional comments (if any) on the Applicant’s character (attach separate
sheet if necessary):-

I agree to provide, if required, details about my acquaintance with the Applicant and my knowledge
of the Applicant’s character. The Medical Council can contact me at the address, telephone number or
email set out below.

I certify that the above information is, to the best of my knowledge, true and correct.

Signature : __________________________________________

Name : (BLOCK letters)

Occupation / Profession : __________________________________________

Address : __________________________________________

Telephone No. : __________________________________________

Email : __________________________________________

Date : __________________________________________

WARNING

It is an offence punishable with imprisonment under the Crimes Ordinance to aid, abet or counsel the Applicant to
procure or attempt to procure himself or herself to be registered as a medical practitioner under section 14A of the
Medical Practitioners Ordinance by wilfully making or producing a certificate of character reference which the referee
knows to be false or fraudulent. Referee must therefore ensure all information provided in this character reference is
true and accurate.

4
(Rev. Apr 2018)
 THE MEDICAL COUNCIL OF HONG KONG

Application for Limited Registration under Promulgation No. 4

Character Reference (2)
I recommend ________________________________(Applicant’s name) for limited registration as
a medical practitioner under section 14A of the Medical Registration Ordinance.

I am not a relative of the Applicant. I have known the Applicant for at least 12 months. I have
sufficient opportunity of judging the Applicant’s character, in the following capacities:-

In my judgment, the Applicant is a person of good character and is fit and proper to be registered as
a medical practitioner with limited registration.

I have the following additional comments (if any) on the Applicant’s character (attach separate
sheet if necessary):-

I agree to provide, if required, details about my acquaintance with the Applicant and my knowledge
of the Applicant’s character. The Medical Council can contact me at the address, telephone number or
email set out below.

I certify that the above information is, to the best of my knowledge, true and correct.

Signature : __________________________________________

Name : (BLOCK letters)

Occupation / Profession : __________________________________________

Address : __________________________________________

Telephone No. : __________________________________________

Email : __________________________________________

Date : __________________________________________

WARNING

It is an offence punishable with imprisonment under the Crimes Ordinance to aid, abet or counsel the Applicant to
procure or attempt to procure himself or herself to be registered as a medical practitioner under section 14A of the
Medical Practitioners Ordinance by wilfully making or producing a certificate of character reference which the referee
knows to be false or fraudulent. Referee must therefore ensure all information provided in this character reference is
true and accurate.

5
(Rev. Apr 2018)
 Personal Information Collection Statement
Purpose of Collection
1. The personal data you provide will be used for purposes directly related to your
application for registration as a registered medical practitioner with limited registration. It is
voluntary for you to provide your personal data. However, if you do not provide sufficient
information, we may not be able to process your application.

Disclosure to the Public

2. In accordance with section 15 of the Medical Registration Ordinance, Part I and Part III
of the General Register are published annually in the Gazette, setting out the names, addresses,
qualifications and dates of the qualifications of all persons included therein. The information
published in the Gazette will also be published in the website of the Medical Council of Hong
Kong. The main purpose of such publication is to inform the public who is, or is not, registered
as a medical practitioner, and who is entitled to practise medicine.

Transfer to Others
3. The personal data you provide will be used mainly by the Medical Council of Hong
Kong. They may also be disclosed to other persons, bodies or authorities for the purposes set
out in paragraph 1 above or in circumstances permitted under the Personal Data (Privacy)
Ordinance.

Access to Personal Data

4. You have a right to request access to and correction of your personal data held by us.
A fee may be charged for such access or correction. Request for access or correction should be
made in writing to:-

Secretary, The Medical Council of Hong Kong

c/o Central Registration Office
17/F, Wu Chung House
213, Queen’s Road East
Wanchai, Hong Kong

6
(Rev. Apr 2018)
 Application for Limited Registration under Promulgation No. 4
Guidance Note
Pursuant to section 14A of the Medical Registration Ordinance (“MRO”), Chapter 161, Laws of
Hong Kong, the Medical Council of Hong Kong has determined that until such time as it may take
a contrary determination the following employment is appropriate and necessary for limited
registration under the MRO:-

“Being such persons (whose names were entered prior to the end of 1964 into a list
maintained by the Registrar of Clinics, Department of Health and who are or who have
been registered under Promulgation No. 3 of the Medical Council of Hong Kong on
Limited Registration) appointed for the provision of primary healthcare, and to be
responsible for the medical management of those clinics registered under the Medical
Clinics Ordinance, Chapter 343 of the Laws of Hong Kong.”

Persons registered as medical practitioners with limited registration under promulgation no. 4 shall
be subject to the following restrictions and conditions regarding their practice:-

(1) the Professional Code and Conduct for the Guidance of Registered Medical
Practitioners, published by the Council; and

(2) the Code of Practice for Medical Practitioners Registered with Limited Registration in
accordance with Promulgation No. 4, published by the Council.

Please note the following in making the application:-

1. Complete application form clearly and in BLOCK letters. Incomplete or illegible

applications will not be processed. Documents submitted will not be returned.

2. Make a statutory declaration before a Commissioner for Oaths, Solicitor or Barrister in Hong
Kong or a Notary Public outside Hong Kong to confirm the truth of all information provided.
Declaration service is also available free of charge at the Central Registration Office.

3. Submit:-

(a) photocopy of the identity document (Hong Kong Identity Card or passport), which must
be

(i) certified true copies by the administrator of oath before whom the statutory
declaration is made; or
(ii) verified by the Central Registration Office (you must present both the originals
and the photocopies in person for verification);

(b) originals of the following:-

(i) 4 recent photographs (size: 40 x 60mm to 50 x 70mm), one of which to be

affixed to application form;

7
(Rev. Apr 2018)
 (ii) an official letter from the employer/employing institution certifying that you
have been appointed for the provision of primary healthcare and you are
responsible for the medical management of a clinic registered under the Medical
Clinics Ordinance, Cap. 343 and that your appointment is necessary and
appropriate to meet the community’s need for medical service (the name chop of
the employing institution has to be stamped on the official letter); and
(iii) references as to your character from at least 2 persons, not being your relatives,
who have known you for at least 12 months and who have the opportunity of
judging your character;

(c) a crossed cheque or banker’s draft for HK$1,675* made payable to “The Government of
the HKSAR” or “The Government of the Hong Kong Special Administrative
Region”. (HK$1,270* being prescribed fee for limited registration and HK$405* being
fee for the practising certificate for the first year of registration. Practising certificate(s)
for subsequent year(s) will be charged separately if limited registration will be granted for
more than one year.) [*Fees subject to revision]

4. Completed application form, together with all supporting documents and the prescribed fees,
should be submitted in person or by post to:-
Registrar of Medical Practitioners
c/o Central Registration Office
17/F, Wu Chung House
213, Queen’s Road East
Wanchai, Hong Kong

5. Enquiries should be directed to the Central Registration Office at 2961 8648.

8
(Rev. Apr 2018)
 Note to Applicants

Waiver of Registration and Related Fees for Healthcare Professionals

As a token of appreciation to healthcare professionals in the fight against

coronavirus disease-2019, the fees payable in respect of statutory registration / enrolment
as well as issuance and/or renewal of practising certificates for 13 healthcare professions
that take effect during the 3-year concession period from 1 July 2020 to 30 June 2023 will
be waived by the Government if certain criteria are met.

2. Pursuant to Medical Practitioners (Fee Concessions) Regulation 2020, the fees

payable for the first time registration in any part of the General Register and Specialist
Register and the issuance / renewal of practising certificates for up to 3 times that first take
effect during the concession period will be waived.

The Medical Council of Hong Kong